The Division would like to provide notice that the Commissioner has adopted the following amended regulations:
- Regulation 3-1-15 Premium Deficiency Reserve Standards for Individual and Group Health Benefit Plans - This regulation will become effective on March 15, 2021.
The purpose of this regulation is to establish minimum standards for determining when a Premium Deficiency Reserve is necessary, for companies providing individual and group health coverage, and to implement rules for calculating the reserve.
- Regulation 4-2-17 Prompt Investigation of Health Claims Involving Utilization Review and Denial of Benefits and Rules Related to Internal Claims and Appeals Processes - This regulation will become effective on March 15, 2021.
The purpose of this regulation is to set forth guidelines for carrier compliance with the provisions of §§ 10-3-1104(1)(h), 10-16-409(1)(a), and 10-16-113, C.R.S., in situations involving utilization review and certain denials of benefits for treatment, as well as rescission, cancellation, or denial of coverage based on an eligibility determination, as described herein. Among other things, § 10-3-1104(1)(h), C.R.S., requires carriers to adopt and implement reasonable standards for the prompt investigation of claims arising from health coverage plans; promptly provide a reasonable explanation of the basis in the health coverage plan in relation to the facts or applicable law for denial of a claim or for the offer of a compromise settlement; and refrain from denying a claim without conducting a reasonable investigation based upon all available information.
- Regulation 4-3-1 Minimum Standards for Medicare Supplement Policies - This regulation will become effective on March 15, 2021.
The purpose of this regulation is to provide for the reasonable standardization of coverage and simplification of terms and benefits of Medicare supplement policies; to facilitate public understanding and comparison of such policies; to eliminate provisions contained in such policies which may be misleading or confusing in connection with the purchase of such policies or with the settlement of claims; to provide for full disclosure in the sale of accident and sickness insurance coverage to persons eligible for Medicare; and to comply with the mandate of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) which prohibit the sale of Medicare supplement benefit policies that cover Medicare Part B deductibles to “newly eligible” Medicare beneficiaries defined as those individuals who become eligible for Medicare due to age, disability or end-stage renal disease, on or after January 1, 2020.
- Regulation 7-1-1 Registration Requirements, Fees for Cash-Bonding Agents and Professional Cash-Bail Agents - This regulation will become effective on March 15, 2021.
The purpose of this regulation is to set forth the procedures and fees related to obtaining, maintaining, renewing and reinstating registration as a Cash-Bonding Agent or Professional Cash-Bail agent with the Division. This regulation also sets forth the format for filing the premium fee statement required by § 10-23-104(1)(d), C.R.S and paying the associated premium fee required by § 10-23-104, C.R.S
Find this regulation and other regulations that have been adopted, but are not yet effective, at Regulations Adopted But Not Yet Effective.
Division bulletins and regulations can be found at Statutes, Regulations & Bulletins.